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[Focus on Achalasia].

Marie-Anne Guillaumot1, Maximilien Barret1, Sarah Leblanc1

  • 1Hôpital Cochin, service de gastroentérologie, 75014 Paris, France; Faculté Paris Descartes, 75014 Paris, France.

Presse Medicale (Paris, France : 1983)
|September 19, 2017
PubMed
Summary
This summary is machine-generated.

Achalasia pathophysiology involves esophageal nerve damage. High-resolution manometry aids diagnosis, while treatments like pneumodilatation and Heller myotomy show high success but carry risks such as perforation or reflux.

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Area of Science:

  • Gastroenterology
  • Esophageal Motility Disorders

Background:

  • The exact cause of achalasia, a rare esophageal motility disorder, remains unclear.
  • It is characterized by the degeneration of ganglion cells within the esophageal myenteric plexus.
  • This leads to impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax.

Purpose of the Study:

  • To review the current understanding of achalasia pathophysiology.
  • To highlight the diagnostic role of high-resolution esophageal manometry.
  • To compare the efficacy and safety of current treatment modalities for achalasia.

Main Methods:

  • Literature review of pathophysiology, diagnosis, and treatment of achalasia.
  • Analysis of data regarding high-resolution esophageal manometry findings.
  • Comparison of success rates and complications for endoscopic pneumodilatation, laparoscopic Heller myotomy, and peroral endoscopic myotomy.

Main Results:

  • High-resolution esophageal manometry is crucial for diagnosing achalasia.
  • Both endoscopic pneumodilatation and laparoscopic Heller myotomy achieve approximately 90% short-term success.
  • Esophageal perforation is the primary risk of pneumodilatation (approx. 1%), while peroral endoscopic myotomy is associated with significant post-procedural gastroesophageal reflux.

Conclusions:

  • Achalasia management requires understanding its underlying pathophysiology and diagnostic tools.
  • Established treatments offer high efficacy but necessitate careful consideration of potential complications.
  • Emerging techniques like peroral endoscopic myotomy present a promising alternative, though reflux remains a concern.